Chua Elise, Navaratnam Annakan V, St Leger Dominic, Lam Vincent, Unadkat Samit, Weller Alexander
Departments of Radiology, Northwick Park and Central Middlesex Hospitals, London North West University Healthcare NHS Trust, Watford Road, Harrow HA1 3UJ, UK.
Departments of ENT Surgery, Northwick Park and Central Middlesex Hospitals, London North West University Healthcare NHS Trust, Watford Road, Harrow HA1 3UJ, UK.
Radiol Res Pract. 2021 Jul 9;2021:5313196. doi: 10.1155/2021/5313196. eCollection 2021.
To evaluate the diagnostic performance of MRI compared with CT in differentiating neoplastic from infectious/inflammatory causes of complete unilateral maxillary sinus opacification (UMSO). Although MRI is increasingly used, no studies validate its utility compared to CT or nasal endoscopy in this context.
A retrospective analysis of 49 patients presenting with complete UMSO to a tertiary referral centre was performed, investigated with both CT and MRI. Two head and neck radiologists independently reviewed each imaging modality and recorded both a final diagnosis and Likert-scale diagnostic certainty score. A consensus radiological diagnosis was determined, stratified into potentially neoplastic or infectious/inflammatory aetiology, and compared with nasal endoscopy and final diagnosis. Diagnostic performance and interoperator agreement for predicting neoplasia were calculated.
Both CT and MRI demonstrated high sensitivity and negative predictive value for neoplasm, although MRI was more specific (79%; 95% CI: 60-92%) than CT (14%; 95% CI: 4-32%), with a higher positive predictive value. MRI was more accurate (88%; 95% CI: 75-95%) than CT (49%; 95% CI: 34-64%) in diagnosing neoplasia. MRI had significantly higher diagnostic certainty Likert scores than CT ( < 0.0001 for both observers). Interobserver agreement was fair for CT (kappa coefficient = 0.327) and excellent for MRI (kappa coefficient = 0.918).
MRI is more specific than CT in characterising UMSO, with greater diagnostic certainty and reproducibility. The additive diagnostic value of MRI complements CT, potentially reducing diagnostic delays in some cases and the need for diagnostic endoscopic sinus surgery in others. We recommend MRI incorporation into the diagnostic pathway for patients with UMSO.
评估磁共振成像（MRI）与计算机断层扫描（CT）在鉴别单侧上颌窦完全性混浊（UMSO）的肿瘤性病因与感染性/炎症性病因方面的诊断性能。尽管MRI的应用越来越广泛，但在此背景下，尚无研究验证其与CT或鼻内镜相比的效用。
对一家三级转诊中心的49例表现为UMSO的患者进行回顾性分析，这些患者均接受了CT和MRI检查。两名头颈放射科医生独立评估每种成像方式，并记录最终诊断结果和李克特量表诊断确定性评分。确定了放射学共识诊断，分为潜在肿瘤性或感染性/炎症性病因，并与鼻内镜检查和最终诊断结果进行比较。计算预测肿瘤形成的诊断性能和操作者间一致性。
CT和MRI对肿瘤均显示出高敏感性和阴性预测值，尽管MRI比CT更具特异性（79%；95%可信区间：60 - 92%），而CT为（14%；95%可信区间：4 - 32%），且MRI具有更高的阳性预测值。在诊断肿瘤方面，MRI比CT更准确（88%；95%可信区间：75 - 95%），而CT为（49%；95%可信区间：34 - 64%）。MRI的诊断确定性李克特评分显著高于CT（两位观察者的P值均<0.0001）。CT的观察者间一致性一般（kappa系数 = 0.327），而MRI的观察者间一致性极佳（kappa系数 = 0.918）。
MRI在UMSO特征性诊断方面比CT更具特异性，具有更高的诊断确定性和可重复性。MRI的附加诊断价值可补充CT，在某些情况下可能减少诊断延迟，在其他情况下可减少诊断性鼻内镜鼻窦手术的需求。我们建议将MRI纳入UMSO患者的诊断流程。
